Chronic care management with CPT codes 99490 is started by a Medicare which takes effect from 1 Jan 2015. This service starts for a patient who is suffering from multiple chronic conditions. According to survey, in 2015 approx. 25% of adults have 2 or more chronic condition, 50% of adults has 1 or more chronic condition. The new reimbursements are in line with the CMS’s moves to focus on higher quality primary care to reduce the effort and increase the results. There are many in and out of these services. But before going deep to get the in-depth knowledge let’s take little knowledge about their basic
Who is Eligible?
For getting the eligibility in CCM Services patient has to fulfill these three criteria:
- Patient must have two or more chronic conditions.
- Condition is expected to be last at least for 12 months or until death of the patient.
- Condition places the patients at significant risk of death, functional decline or acute exacerbation.
Basically the CMS does not have a list of chronic condition, they mainly provides a concise summary of condition that may apply. They also contain the data of chronic conditions which is very helpful resource for the healthcare providers and physicians. The decision totally depends upon the treating healthcare provider that what they consider a disease chronic; with the responsibility of delivering information that support the chart documentation and a suitable care plan. Also check the Benefits of Maintaining Own Personal Health Record.
Eligible Healthcare Providers:-
Any healthcare provider whether it was physician or non- physician may charge for the chronic care management services:
- Nurse Practitioners
- Physician Assistance
- Clinical Nurse Professional
- Specialized Nurse Midwives
Apart from that the clinical staffs who working under the general supervision of eligible healthcare provider can also provide the CCM services
But apart from this if two healthcare providers providing a CCM service to the same patient, then the only one healthcare provider will get the fee for the code in the specified month
Patient Agreement and Consent
In this process of receiving the CCM Services, it is necessary to assured that the patient is clearly understood the medical services and the financial allegations.
This patient’s agreement is like an Advanced Beneficiary Notice (ABN) which is necessary to complete before starting the service or treatment. This is an alternative by healthcare providers or physician creating their own agreement that must include:
- The services and treatment with the possible cost-sharing expenses.
- Cancellation policy by simply abandoning the agreement, active in the end of the month.
- CCM Availability and obtaining the written authorization for services.
- CCM billing limitation that only one healthcare provider can get the reimbursement in the end of calendar month for the services or treatment.
The above mention factors should clearly define in the medical record of the patient. And the changes, revocation and consent in CCM services are also mention in the medical record of patient.